Healthcare Provider Details

I. General information

NPI: 1811065618
Provider Name (Legal Business Name): WESKOTA MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 1ST ST NE
WESSINGTON SPRINGS SD
57382-2134
US

IV. Provider business mailing address

608 1ST ST NE
WESSINGTON SPRINGS SD
57382-2134
US

V. Phone/Fax

Practice location:
  • Phone: 605-539-1621
  • Fax: 605-539-4502
Mailing address:
  • Phone: 605-539-1621
  • Fax: 605-539-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number10707
License Number StateSD

VIII. Authorized Official

Name: MRS. KAYLEEN R LEE
Title or Position: ADMINISTRATOR
Credential:
Phone: 605-539-1621